Healthcare Provider Details

I. General information

NPI: 1821091596
Provider Name (Legal Business Name): EXPRESS CARE PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E BROADWAY UNIT A
GLENDALE CA
91205-4528
US

IV. Provider business mailing address

801 E BROADWAY UNIT A
GLENDALE CA
91205-4528
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-3330
  • Fax: 818-244-5530
Mailing address:
  • Phone: 818-244-3330
  • Fax: 818-244-5530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY50437
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY50437
License Number StateCA

VIII. Authorized Official

Name: MR. MIKAYEL MIKAYELYAN
Title or Position: PRESIDENT
Credential:
Phone: 818-244-3330